Effects of Nordic Walking on Physical Fitness in Patients with Cancer: A Systematic Review

Background: Despite evidence supporting exercise in cancer care, adherence remains low. Nordic Walking (NW), a pole-assisted outdoor activity, may overcome barriers and improve fitness. However, a comprehensive synthesis of its effects on physical fitness in cancer patients is lacking. Objective: To evaluate NW's effects on physical fitness, health-related quality of life (HRQoL), adherence, and safety in patients living with and beyond cancer, compared with no intervention or other exercise programs. Methods: This PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD42024551608) included randomized or quasi-randomized trials. Five databases were searched through November 2024. Risk of bias (Joanna Briggs Institute) and evidence certainty (GRADE) were assessed. Results: This systematic review included six RCTs comparing NW with no intervention. NW significantly improved overall muscle strength (Std. MD = 0.46, 95%CI:0.14-0.78; low-certainty) and self-reported physical activity (MD = 3181.51 MET-min/week, 95%CI:2085-4278; moderate-certainty). Cardiorespiratory fitness (6-min walk) showed no significant improvement in random-effects modeling (MD = 84.78 m, 95%CI:-35.6-205.19; very low-certainty). HRQoL data were insufficient for meta-analysis. Adherence exceeded 90% in supervised sessions, with no serious intervention-related adverse events. Conclusions: When compared with no intervention NW is feasible and safe, potentially improving muscle strength and physical activity in patients with cancer. Evidence for cardiorespiratory endurance and HRQoL remains inconclusive. To date, no studies have compared NW with other structured exercise programs. Higher-quality RCTs with diverse populations are needed.